[en] Hypercalciuria is the main risk factor for recurrent calcium urolithiasis. The goal of our study is to determinate how useful an oral calcium load test is for stone formers to classify different forms of hypercalciuria in pathogenetic categories defined as renal or absorptive according to the current knowledge. Between June 2013 and February 2016, a prospective study was carried out on 117 documented recurrent hypercalciuric stone formers undergoing an oral calcium load test modified from the original description by Pak. After 2 days of calcium-restricted diet, urine and blood were analyzed at baseline and 120 min after receiving orally 1 g of calcium. Total and ionized calcium, parathyroid hormone from serum and urine calcium and creatinine were assessed in order to divide patients in three groups as previously described: resorptive, absorptive, and renal hypercalciuria. This allowed the identification of 19, 39, 34 and 33 patients with normocalcemic primary hyperparathyroidism (NPHPT), renal hypercalciuria aka renal calcium leak (RCL), absorptive hypercalciuria (AH) and unidentified cause, respectively. Patients with NPHPT (who required parathyroidectomy) experienced a lower PTH decrease (41.41 ± 12.82 vs. 54.06 ± 13.84% p < 0.01), higher beta-crosslaps, as well as lower TmP/GFR and distal third radius bone mineral density. RCL resulted in increased fasting urine calcium-to-creatinine ratio (Uca/Cr), i.e., > 0.37 mmol/mmol), without hyperparathyroidism. AH was diagnosed by the presence of ΔUCa/Cr > 0.60 mmol/mmol between baseline and 120 min without any other anomaly. For all remaining patients, results were inconclusive due to the lack of sufficient increase in serum calcium or because the cause of lithogenesis could not be clearly identified. The oral calcium load test is useful in nearly 80% of patients by identifying the different forms of hypercalciuria causing urolithiasis and by guiding treatment, including parathyroid surgery.
Disciplines :
Laboratory medicine & medical technology Urology & nephrology
Author, co-author :
Tostivint, Isabelle N ; Department of Nephrology, AP-HP, Pitie Salpetriere Hospital, 48 Boulevard de l'Hôpital, 75013, Paris, France. isabelle.tostivint@aphp.fr ; GRC 20 SORBONNE UNIVERSITY Clinical multidisciplinary Research Group on Kidney Stones, Sorbonne University Tenon Hospital, Paris, France. isabelle.tostivint@aphp.fr
Castiglione, Vincent ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chimie clinique
Alkouri, Rana; Department of Metabolic Biochemistry, AP-HP, Pitie Salpetriere Hospital, Paris, France
Bertocchio, Jean Philippe; Department of Nephrology, AP-HP, Pitie Salpetriere Hospital, 48 Boulevard de l'Hôpital, 75013, Paris, France ; Rare Diseases Network OSCAR, Center for Excellence in Rare Calcium and Phosphate Disorders, Paris, France
Inaoui, Rachida; Department of Rheumatology, AP-HP, Pitie Salpetriere Hospital, Paris, France
Daudon, Michel; Department of Biochemistry, Cristal Laboratory, AP-HP, Tenon Hospital, Paris, France
Dousseaux, Marie-Paule; Department of Nutrition and Dietetics, AP-HP, Pitie Salpetriere Hospital, Paris, France
Cavalier, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chimie clinique
Pieroni, Laurence; Department of Metabolic Biochemistry, AP-HP, Pitie Salpetriere Hospital, Paris, France ; Department of Biochemistry, Cristal Laboratory, AP-HP, Tenon Hospital, Paris, France
Izzedine, Hassan; Department of Nephrology, Peupliers Private Hospital, Paris, France
Language :
English
Title :
How useful is an oral calcium load test for diagnosing recurrent calcium stone formers?
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